A Brief, Integrated Intervention for Women Veterans with Unhealthy Alcohol Use in Primary Care

Unhealthy alcohol use is increasingly prevalent among women, and women Veterans in particular, and is associated with extensive functional impairment, especially when it co-occurs with psychiatric symptoms (e.g., insomnia). Psychosocial functioning can improve independently of alcohol use, but much alcohol treatment research evaluates primarily alcohol use. Women have been less involved in alcohol treatment research, which is harmful because of known differences among men and women related to alcohol use, including greater risk of some alcohol-related medical conditions, more comorbid psychiatric symptoms, and more alcohol-related stigma among women than men. Women are more likely than men to experience “telescoping,” a pattern of rapid progression from initiation to problematic use that narrows the window for intervention. Integrated Primary Care (IPC) may narrow the treatment gap for women Veterans. Developing brief interventions in IPC is an established and effective practice for other psychiatric symptoms (e.g., PTSD, insomnia), yet we do not know of a comparable intervention for unhealthy alcohol use among women Veterans. This proposal aims to combine effective elements of interventions for alcohol and comorbid psychiatric symptoms into a single, brief intervention in IPC and evaluate the intervention with respect to psychosocial functioning. Dr. Katherine Buckheit is a clinical psychologist at the Veterans Affairs (VA) Center for Integrated Healthcare (CIH), a VA Mental Health Center of Excellence focused on improving healthcare by incorporating mental health treatment into medical settings. This K01 Mentored Research Scientist award will enable Dr. Buckheit’s transition to an independent investigator with a long-term goal of improving alcohol treatment by designing, evaluating, and implementing brief interventions in medical settings. Her short-term goal and specific focus of this K01 is to obtain expert mentorship and formal training and conduct a series of research projects to develop and evaluate a brief intervention for women Veterans with unhealthy alcohol use in IPC. This K01 will provide Dr. Buckheit with training in key areas: 1) designing and evaluating brief interventions in IPC, 2) evidence-based alcohol treatment in IPC and specialty care, 3) intervention development among groups with unmet healthcare needs, and 4) mixed-methods and advanced longitudinal statistical analyses. Specific aims are: 1) Combine elements of evidence-based interventions for alcohol use and co-occurring symptoms into a single brief (≤ 6, 30-minute sessions) intervention that includes content for women Veterans. We will engage subject matter experts (IPC, substance use, women’s health) to solicit feedback and refine the intervention. 2) Conduct an open trial (N=10) to gather patient feedback and finalize the intervention. 3) Conduct a pilot randomized controlled trial (RCT; N=60) to evaluate research and clinical feasibility, acceptability, and preliminary effectiveness in improving quality of life, alcohol problems, and alcohol-related functional impairment compared to primary care usual care. Results will inform an R01 application to be submitted by the end of Year 4.